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Referral / Authorization Specialist - Access Coordinator (Remote)

Seattle, WA

Job Title: Healthcare Access Coordinator

Location: West Coast - Pacific Time Zone 

Pay: Competitive hourly rate

Work Arrangement: 100% Remote

Experience Required: 1+ Years of Relevant Experience

Company Overview:

Our organization is committed to enhancing the healthcare journey for our members. We are dedicated to delivering accessible, high-quality care tailored to the unique needs of our communities. As a Healthcare Access Coordinator, you will play a crucial role in ensuring our members promptly receive the services they require.

Position Summary:

The Healthcare Access Coordinator is responsible for efficiently managing the access to healthcare services for our members. This role entails close collaboration with healthcare providers, members, and internal teams to facilitate the approval of medical services. The Coordinator will ensure the precise processing of referrals and authorizations, all in alignment with our organization's policies and regulatory standards.

Key Responsibilities:

  • Access Management: Efficiently process referrals from healthcare providers, ensuring completeness and accuracy. Verify member eligibility and coverage to ascertain authorization needs.

  • Authorization Handling: Initiate and oversee the authorization procedure, including the acquisition of necessary documentation and approvals. Engage with providers to gather additional information when necessary.

  • Documentation: Maintain meticulous records of all referrals and authorizations within our system. Guarantee the completeness, accuracy, and currency of documentation.

  • Effective Communication: Collaborate with healthcare providers, members, and internal teams to ensure the timely approval of medical services. Communicate authorization determinations to relevant parties.

  • Regulatory Compliance: Stay updated on pertinent laws, regulations, and policies concerning referrals and authorizations. Ensure adherence to these requirements across all processes.

  • Issue Resolution: Address and resolve concerns or disparities related to referrals and authorizations. Escalate intricate cases when needed.

  • Quality Control: Conduct regular audits of the referral and authorization processes to identify avenues for improvement. Implement best practices to enhance efficiency and precision.

  • Reporting: Generate reports detailing referral and authorization metrics, encompassing turnaround times, approval rates, and any pending cases.

  • Training: Facilitate the training of new team members and providers on referral and authorization procedures.

Qualifications:

  • Education: High school diploma or equivalent. Additional college coursework in healthcare administration or related fields is advantageous.

  • Experience: 1+ year of experience in referral and authorization coordination within the healthcare or managed care sector.

  • Technical Proficiency: Proficient in using computer systems and software, particularly Microsoft Office and relevant healthcare management applications.

  • Communication Skills: Strong verbal and written communication skills, with the ability to interact professionally with providers and internal teams.

  • Organizational Aptitude: Excellent organizational and time-management skills for managing multiple referrals and authorizations simultaneously.

  • Attention to Detail: A keen eye for detail is essential to ensure the accuracy of referral and authorization processes.

  • Problem-Solving: Effective problem-solving skills to address issues and discrepancies.

  • Adaptability: Ability to adapt to changes in policies and procedures.

  • Team Player: Collaborative and willing to work as part of a team to achieve shared objectives.

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